Management of Labor

Conclusion Grading Worksheet B – Annotation #66 Management of Labor
(Management of Protracted Labor) Third Edition/May 2009
Authors' Conclusions/
Work Group's Comments (italicized)
Population Studied/Sample Size Primary Outcome Measure(s)/Results (e.g., p-value,
confidence interval, relative risk, odds ratio, likelihood
ratio, number needed to treat)
-Defined CS as due to dystocia when indication was
women; before and after intro- failure to progress or cephalopelvic disproportion;
duction of AML program (two also defined CS for fetal distress, breech presenta-
6-month periods in each phase) tion and "other"
Class Quality
+,–,ø
Author/Year Design
Type
-The incidence of CS for indication of
dystocia in nulliparous women may be reduced
by AML.
C ø -3,900 births to nulliparous
-Outcomes:
Non-
Random/HistoricalControls
Boylan,
Frankowski,
Rountree, Selwyn,
& Parrish
(1991)
NOTES: before-after design cannot isolate
the effects of specific components of an
AML policy
Work Group's Comments: did sample size
analysis to detect at least a 20% relative decrease
in incidence of CS between control
and initial AML period with 90% power at
p=0.05
Control Period AML Period
(1,843 births) (2,057 births)
1 2 Tot. 1 2 Tot.
% Caesarean 23 24 24 20 18 19
% Dystocia 57 58 48 46
% Forceps 36 30
% Spont. Vaginal 40 51
NOTE: 1 and 2 refer to 1st 6 mos and 2nd 6 mos
-5.5% drop during AML period in incidence
(p